To the Editor.
—Four comments to the important article of Rothroch et al on migraine and stroke that appeared in the Archives.1The incidence of mitral valve prolapse in migraine is larger than 6% in most reports.2 Given the incidence of 15% to 25% of migraine in the general population, and 5% to 12% of mitral valve prolapse, the combined incidence would be about 14%. Echocardiography can yield false-negative results in up to 22% of cases.3 Further-more, we have described a subset of migrainous women who have mitral valve prolapse in just about 100% of cases.4 This is of more than passing interest, since propranolol hydrochloride (Inderal) is the drug of choice in this subgroup.5Doppler studies of the extracranial circulation should be preferred to angiography, as the latter becomes less and less the "golden rule."6 In addition to excellent accuracy7 and
Herman P. Migraine and Mitral Valve Prolapse. Arch Neurol. 1989;46(11):1165. doi:10.1001/archneur.1989.00520470015008
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